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94 CHAPTER 5 CHRONIC TTH ANALYSIS BY EMG AND GSR BIOFEEDBACK

The Internet-of-things (IoT) is a system or network that connects all physical objects to the Internet
through routers or network devices to collect and share data without manual intervention. IoT provides
a common platform and language for all physical devices to dump their data and to communicate with
each other. Data emitted from various sensors are securely provided to IoT platforms and is integrated.
Necessary and valuable information is extracted. Finally, results are shared with other devices to
improve the efficiency and for better user experience automation.

5.2 PREVIOUS STUDIES (LITERATURE REVIEW)
5.2.1 TENSION TYPE HEADACHE AND STRESS
It is a state of physiological or psychological stress due to undesirable stimuli, physical, mental, or
emotional; internal or external that could likely disturb the functioning of an individual [10]. Acute
stress is generally short-lived and causes no actual damage, whereas chronic stress can cause a sus-
tained response to stress, causing damage and chronic pain. Stress reactions (response to stress) cause
amplification of physiological parameters such as muscle tension, blood pressure, increased sweating,
etc. This causes disorders in the body such as headaches, irritable bowel syndrome, ulcers, hyperhidro-
sis, chest pain, etc. Eventually, it results in a vicious cycle wherein stress causes pain or stress-related
disorders and increased pain or other symptoms, which leads to further amplification of stress [11].
Mental stress and tension are the most frequently recorded activator of chronic TTH tension-type
headaches [12,13]. Genetic or family-related social and environmental factors are also associated with
TTH [11,14]. In addition to physical variables such as muscle tension, electro-dermal activity, temper-
ature, etc. and other demographic variables of pain, the occurrence of headaches is empirically asso-
ciated with psychological risk factor. These comprise social support, hypnotizability, affect, life events,
and negative thinking [11]. Genetically negative affectivity is raised in chronic headache sufferers,
causing overreporting of somatic symptoms like headaches, irrespective of organic disease [12,13].
This indicates that mental health is largely affected in patients with TTH and therefore a good deal
of attention should be paid to the psychological component in terms of assessing and taking measures
to improve the mental health of patients with TTH.
A headache is a clinical syndrome affecting 91% of males and 96% of females at some time during
their life. The World Health Organization recognized that primary headaches are among the first 20
major causes of disability. In the primary care practice, the tension type headache is the most com-
monly diagnosed variety of primary headache. Due to tension, the formerly called tension headache
or muscle contraction headache is the most frequently occurring headache disorder. It is the most com-
mon among primary headaches.
It is the most dominant and costly headache. Tension type headaches are responsible for nearly 90%
of all headaches. According to the International Headache Society (IHS), its lifetime occurrence in the
overall population observed in different studies varies from 30% to 78%. In spite of its high prevalence
and regardless of the fact that it has the highest socio-economic impact, it is still the least studied of the
primary headache disorders.
Published estimates of the prevalence of the tension type headache vary over a wide range from
1.3% to 65% in men and 2.7% to 86% in women [15]. A World Health Organization (WHO) statement
released in 2000 on headache disorders and public health quotes that the onset of TTH is often in ad-
olescence and prevalence peaks in the fourth decade and subsequently declines [16], whereas the